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Health services in York 'praying' to avoid financial crisis
Health services in York are under more pressure than ever and working to avoid financial crisis. Chair of the Vale of York Clinical Commissioning Group Alan Maynard speaks to health reporter Kate Liptrot.
ALAN Maynard readily admits he hasn’t seen a situation like it in 30 years.
Faced with the task of overseeing a £360 million budget which pays for health services from prescriptions to hospital treatment, the outspoken former chair of York Hospital has been open in his concern about the struggle to balance the books of the Vale of York Clinical Commisioning Group (CCG).
Coping with Government funding restrictions and huge performance pressures, the health economist has already spoken of his concern the group will end its first year with a deficit.
Prof Maynard said: “Shall we say it’s the most interesting situation I have ever been in in 30 years.
“It’s a tremendous challenge. If you want to adopt a conspiracy theory – which I wouldn’t – it’s about the straws that break the camel’s back.
“From a management point of view it’s something we have got to handle and make sure it doesn’t break the camel’s back.
“You can have a dismal scenario which says ‘oh woe unto me’ or you can say that’s what we are hired for. I’m relatively optimistic.”
In the red from its launch in April, the Vale of York CCG inherited a debt of £3.5 million from the Primary Care Trust which, despite discussion with the Government, has not been written off.
And although local politicians are campaigning for a fairer funding formula per person in North Yorkshire, a newly proposed formula looks set to leave York worse off to the tune of nearly £5 million.
Furthermore, the CCG is already facing overspends of more than a million pounds at a time and is required to “topslice” £12 million or three per cent from its budget for integrated social care from 2015.
“It’s a prayer job because we don’t know how to do it,” Prof Maynard said.
“Currently we are very squeezed and the future is saying we might lose £5 million with a new formula and in 15/16 we have this potential loss of £12 million.”
A problem for the CCG is it is in a position it can do little about. York Hospital has to treat patients if they are referred by their doctors and in turn the CCG has to pay for it.
As a consequence, York Hospital, which receives about 52 per cent of the budget for acute funding, has overspent by £3.2 million.
“We have got no effective cap on volumes. We are in rather a passive position. We talk to them, their response is to say ‘the GPs are refering patients and they are ill, what are we supposed to do?’ So they treat them and then send us the bill.
“I describe it as pass the parcel bomb. Our deficit will mean York Hospital is in balance. If they go into deficit we will be in balance and there’s that play all the time of trying to really get the system more efficient and control costs and activity.
“We are authorised to spend our budget, but we have certain conditions with regard to finance. There’s a lot of oversight going on with regard to our financial position. NHS England is at our shoulder like a parrot on Long John Silver. They are obviously wanting to make sure we make it.
“But it’s quite demanding to make sure we will balance.
“The hope at the moment is we have got a fragile position with regard to finance and if the wind is blowing in our direction we should be alright.”
His optimism is matched by chief clinical officer of the CCG, Dr Mark Hayes, who has said he is confident the end of the year can be reached without a deficit.
Prof Maynard said the Government funding formula tends to give more resources to deprived areas such as Hull or Leeds. Inequalities in neighbouring services can be seen with the lack of funding for IVF in York, which Leeds has, or with counselling services, which are also better funded in Leeds.
These are areas which have traditionally had surpluses but they are no longer allowed to be used as bungs as previously used to bail out North Yorkshire PCT.
“This Government has said no more distribution. Stand on your feet or be shot... which is fair enough,” he said.
Elaborating on Government health policy, Prof Maynard dismisses concerns about gradual privatisation as he thinks David Cameron “knows the averse political consequences”.
But musing on whether the Thatcher-driven separation of provider from purchaser works in the long term, he said: “Is it efficient? That’s what we have to prove and we’ll do our damndest to. That we can control the system.
“But ultimately if we don’t, there’s a political question mark over whether that structure stays in place. And again it was emulated by the New Zealanders, the Scots, the Welsh – they have given it up and gone back to having one set of organisations.
“That’s very controversial stuff,” he said, before acknowledging he’s faced with the task of making it work. “We have got to prove it is an efficient way of working.”
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